To the Editor In an article recently published in JAMA Internal Medicine, Nakagawa1 describes 2 key revelations concerning communicating with patients and/or their families. First, communicating bad news is akin to performing a surgical procedure, and second, that as he was developing his communication skills, he lacked real-time feedback. As a physician communication coach, I agree with Dr Nakagawa’s steps—prepare, proceed, review. However, Nakagawa’s procedure focuses only on well-chosen words in ideal patterns, which is just one side of the issue.